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The question
I'm a healthy guy in my early 30s, and my hair - tons of it - is falling out. Are there any medications I can take? I've heard of a prostate drug that's good for hair loss - but is it safe?
The answer
Hair loss can significantly affect self esteem and is a real issue for many men your age. But before discussing potential medication options, you should know what is causing your hair loss.
If your hair loss is generalized (all over your scalp) and falling out in full strands (not breaking), you may be experiencing something called telogen effluvium. This is a common condition which can occur when there is a shock to your system, which can be emotional and/or physical, which causes your hair roots to be pushed prematurely into a rest state that causes the hair to fall out in large amounts.
This shock could be from medications, illness, a major life stress, or crash diets. Specific illnesses can include thyroid dysfunction, and iron deficiency that can be ruled out with a visit to your doctor.
The hair loss can occur anywhere from 6 weeks to 4 months after the initial shock to your system. The reassuring news is that hair will generally grow back once the trigger is not causing further stress, so no treatment is necessary.
Another common cause of hair loss in men is male pattern baldness. This type of hair loss has a characteristic appearance of thinning of hair from the crown or the top of the head with regression of the hairline around the temples. This type of hair loss is thought to be related to increased levels of a type of testosterone that causes hair follicles to narrow, resulting in decreased hair growth and thinning.
There are two medications, Minoxidil (Rogaine) and Finasteride (Proscar, Propecia) that are used to treat male pattern balding:
Minoxidil is a topical treatment that is applied directly to the scalp that promotes hair growth and thickness. It needs to be used twice daily for at least 3-6 months before changes can be noted. Hair begins to shed less within a couple of months of treatment and by 4-8 months, new hair growth should be apparent. This treatment seems to work best when hair loss has been present for less than 5 years, the hair loss is mostly from the crown of the head and for hair loss that is <10 cm in diameter. The main side effect of minoxidil is possible irritation to the scalp. If you have a history of heart disease, check with your doctor prior to starting this medication.
Finasteride was discovered while researching a treatment for enlarged prostate. As a positive 'side effect', the researchers found that the drug not only helped with controlling prostate size but also increased hair growth in subjects. It works by decreasing the testosterone levels which results in the maintenance of the hair follicle size and promotes hair growth and thickness. It is a medication that can only be prescribed by your doctor and is taken as a once daily pill.
The dose used for hair loss is much lower than that used for the prostate condition, and as such, side effects are minimal. (Rare complaints are decrease in sexual drive, ejaculation concerns and in rare cases can affect mood.)
Regardless of treatment with either minoxidil or finasteride, when these drugs are discontinued, the hair growth reverses in 6-12 months without ongoing treatment.
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